a new paradigm is needed

I posted this on a professional list serve regarding our present "health care" issue, FWIW. Thanks to those here who contributed to some of the information. Hopefully, more can be awakened to just one part of the problem.

A NEW PARADIGM IS NEEDED

Going through the "fun" of implementing the new functional limitation reporting requirements (and PQRS measures), it reinforces my contention that this is just one of many steps which will make healthcare progressively more regimented and restricted for the provider and tightly controlled by the government. Once we are all up to speed with these requirements, additional new requirements will be added, and then again, and again, and again. Paperwork and time demands will mount as reimbursement shrinks. Increasingly, time that should be spent in patient care will have to be allotted to bureaucratic wrangling. In addition, time, energy, and resources previously spent on acquiring and honing clinical skills will be shifted towards learning and mastering the bureaucratic wrangling skills necessary to manage these perpetually mounting administrative demands. The handwriting is on the wall.

Isn't it ironic that these requirements were mandated by the Middle Class Tax Relief Act of 2012? I'd wager that the vast majority of PTs are middle class. I'd also wager that the vast majority did not experience tax relief but rather, the very opposite, especially when one considers that "time is money".

Those who were naively applauding the implementation of Obamacare are, if they have their eyes and ears open, seeing a nightmare slowly unfolding. If Stephen Hemsley, the CEO of UnitedHealthCare, was one of the chief lobbyists in favor of Obamacare (to the point of having all his employees write their representatives, saying how wonderful this plan is for health in America), you know it's not a good idea, either for patients or for providers. With 30,000,000 new people to be insured, who do you think is going to be one of the prime beneficiaries (being a leading provider of low cost, dubious quality insurance) and who do you think is going to pick up the tab for all this (as if this socioeconomic class hasn't been decimated enough)? The 21 new or higher taxes being levied under Obamacare are just one part of the nightmare.

Lee Bellinger, a former Washington, DC insider has reported that one of the unstated intents of Obamacare is to eventually drive independent healthcare practitioners out of business, making it easier for the government to manage healthcare and increasing the wealth of the politically connected corporate elite who will benefit. More and more, healthcare practitioners will be working for large healthcare conglomerates which, more and more, will be working hand-in-hand with insurance companies. Or as the saying goes, "Little by little, more and more will be controlled by fewer and fewer." Doubt that? Look at this.

The ongoing wealth extraction from patients and providers will accelerate and more CEOs will have $775,000,000 in unexercised stock options as part of their compensation packages like Hemsley, courtesy of the "generous" public and healthcare providers who so willingly acquiesce to the process.

Healthcare practitioners will remain captive to this process as long as they are dependent upon the insurance system. But it can be broken away from. A system that educates the public from a very early age in prevention and self administered real health care (instead of providing fix-it-when-it's-broken sickness care), that encourages self responsibility rather than dependency upon external authorities and monies, that weans itself from pharmaceutical and surgical dominance, that charges reasonable fees that are uninflated by massive administrative expenses, and that gets the practitioners off of the assembly line of a numbers driven Wall Street mentality back into the caring and compassion of a quality one-on-one human-to-human interaction is one that I would prefer greatly to what the present system is morphing into.

I, for one, am very glad that, in a couple of years, I will be retiring from full time insurance based private practice. I love what I do, am very good at what I do, have invested a great deal of time and money in acquiring my skills and knowledge, and would like to continue doing what I do but I'm no longer willing to be driven hither and thither by the shifting, ill winds that are blowing. I will reduce my hours to have time for other pursuits, but I would like to keep my brain and body engaged and meet the demand from past patients for my services. Therefore, I will be developing and shifting to a new model of care. I encourage others to explore how they can do the same.

I'm disgusted by all the "something for me that others pay" attitude in the country. I agree with you that the end result of this legislation is to force small practitioners out of business. It is truly a shame. You've mentioned on other threads that you are required to ask questions of your patients. One that comes to mind concerns gun ownership. Would you mind listing (or linking) the questions you are required to ask? Also, are vague answers such as "I dunno" acceptable responses? Any suggestions to circumvent the inappropriate questions without compromising the healthcare provider?

I'm scared of going to a hospital to have anything done. I've heard 3 horror stories from my small circle of friends that had minor surgery and contracted a MRSA http://en.wikipedia.org/wiki/Methicillin-resistant_Staphylococcus_aureus variant. They were put on toxic drips for a couple of weeks to destroy the bugs. One friend's 10 year old girl had to have her gall bladder removed after the treatment because it died from the chemical bath.

ao wrote:

I, for one, am very glad that, in a couple of years, I will be retiring from full time insurance based private practice. I love what I do, am very good at what I do, have invested a great deal of time and money in acquiring my skills and knowledge, and would like to continue doing what I do but I'm no longer willing to be driven hither and thither by the shifting, ill winds that are blowing. I will reduce my hours to have time for other pursuits, but I would like to keep my brain and body engaged and meet the demand from past patients for my services. Therefore, I will be developing and shifting to a new model of care. I encourage others to explore how they can do the same.

This intrigues me. Could you flesh out a little more of your model - at least what you'd ideally expect?

I'm disgusted by all the "something for me that others pay" attitude in the country. I agree with you that the end result of this legislation is to force small practitioners out of business. It is truly a shame. You've mentioned on other threads that you are required to ask questions of your patients. One that comes to mind concerns gun ownership. Would you mind listing (or linking) the questions you are required to ask? Also, are vague answers such as "I dunno" acceptable responses? Any suggestions to circumvent the inappropriate questions without compromising the healthcare provider?

I'm scared of going to a hospital to have anything done. I've heard 3 horror stories from my small circle of friends that had minor surgery and contracted a MRSA http://en.wikipedia.org/wiki/Methicillin-resistant_Staphylococcus_aureus variant. They were put on toxic drips for a couple of weeks to destroy the bugs. One friend's 10 year old girl had to have her gall bladder removed after the treatment because it died from the chemical bath.

ao wrote:

I, for one, am very glad that, in a couple of years, I will be retiring from full time insurance based private practice. I love what I do, am very good at what I do, have invested a great deal of time and money in acquiring my skills and knowledge, and would like to continue doing what I do but I'm no longer willing to be driven hither and thither by the shifting, ill winds that are blowing. I will reduce my hours to have time for other pursuits, but I would like to keep my brain and body engaged and meet the demand from past patients for my services. Therefore, I will be developing and shifting to a new model of care. I encourage others to explore how they can do the same.

This intrigues me. Could you flesh out a little more of your model - at least what you'd ideally expect?

Grover

Hi Grover,

BTW, I want to thank you for the Nutrajoint recommendation. I had forgotten all about recommending gelatin and, if the positive reviewes are any indication, it seems to be an excellent product. I'm picking some up and also will be recommending it to others.

And I wholeheartedly agree with you about the "something for me that others pay" attitude.

Regarding the questions, for me as a non-MD, I don't have to ask all the questions they do such as those about gun ownership. I do have to ask questions to quantify certain things like pain and function that sometimes lend themselves better to qualitative descriptors rather than quantitative descriptors. There was a proposed 17 page Medicare form for us that asked questions regarding personal (such as sexual preference and habits), family, cultural, race, religious, financial, socioeconomic, and other information that I really think the government has no business asking. It would, to me, almost be seen as a cross check on Census information and IRS information as well as getting into all the PC cultural sensitivity information that is not immediately relevant to treating a patient.

As far as I know, you won't compromise the healthcare provider by not answering information that's not needed to treat your condition. Pain rankings, such as your pain at its worst, its least, and presently, in the past 24 hours, week, or month can give useful information to the provider. Stating whether you have a gun or not, will not. If would either leave it blank or write "not applicable" or tell the provider you don't feel comfortable answering that question. Be polite of course, since it's not the healthcare practitioner who's to blame. If questions could put you or your family into what you perceive as personal jeopardy, you may have to make a personal decision as to how accurately you wish to answer that information. For example, if you were asked "Are you ever depressed?", that's such a broad and open-ended question that the vast majority probably, at one time or another in their life, may answer 'yes'. But there's a big difference between the occasional blues and unrelenting suicidal depression. In the former instance, possibly forfeiting your right to possess a firearm could, in future circumstances, place you and your family in a vulnerable position.

My personal standard for how accurately I wish to answer a question is what is the higher good. In other words, if it was WW2 in Europe and I was hiding a Jewish person and was asked by the Gestapo if anyone else was in my house, would I lie to the Gestapo or would I give up the Jewish person? For the moral person, the choice is obvious.

Your concern about having a procedure done is well founded. There are some nasty infections going around and incompetency is not that uncommon. I've recent been dealing with an issue myself but elected self care procedures that, fortunately (and with what I feel was divine intervention), seem to be resolving nicely. People in our area are known for making an 8 hour drive down to the Mayo Clinic to get care. I did it myself for elbow surgery and the outcome was excellent, with me returning to work very quickly. One has to be very discerning nowadays and do their research.

With regards to the model, it's still in planning and development. I'll PM you about it but think of creating and defining your own profession rather than being one that is already out there.

BTW, I want to thank you for the Nutrajoint recommendation. I had forgotten all about recommending gelatin and, if the positive reviewes are any indication, it seems to be an excellent product. I'm picking some up and also will be recommending it to others.

Our prehistoric ancestors had to deal with condtions that were mostly opposite from the ones we deal with today. They only had sweets when fruit got ripe or when they could raid a beehive. They really didn't have any processed foods. About the closest was a freshly killed animal with all the meat eaten off. Some ingeniously inspired individual cracked the bones against a rock to reveal the nutritious marrow inside. They probably also ate whatever cartilage they could find. If the body could assimilate this cartilage, there wasn't a deep need to manufacture it in the body.

Nowadays, the goodness gets stripped out during processing and then gets packaged into a separate product. There are many examples in our modern day system. The less processing of food, the better it is for us. (I'm sure there are exceptions to this rule.)

ao wrote:

Regarding the questions, for me as a non-MD, I don't have to ask all the questions they do such as those about gun ownership. I do have to ask questions to quantify certain things like pain and function that sometimes lend themselves better to qualitative descriptors rather than quantitative descriptors. There was a proposed 17 page Medicare form for us that asked questions regarding personal (such as sexual preference and habits), family, cultural, race, religious, financial, socioeconomic, and other information that I really think the government has no business asking. It would, to me, almost be seen as a cross check on Census information and IRS information as well as getting into all the PC cultural sensitivity information that is not immediately relevant to treating a patient.

As far as I know, you won't compromise the healthcare provider by not answering information that's not needed to treat your condition. Pain rankings, such as your pain at its worst, its least, and presently, in the past 24 hours, week, or month can give useful information to the provider. Stating whether you have a gun or not, will not. If would either leave it blank or write "not applicable" or tell the provider you don't feel comfortable answering that question. Be polite of course, since it's not the healthcare practitioner who's to blame. If questions could put you or your family into what you perceive as personal jeopardy, you may have to make a personal decision as to how accurately you wish to answer that information. For example, if you were asked "Are you ever depressed?", that's such a broad and open-ended question that the vast majority probably, at one time or another in their life, may answer 'yes'. But there's a big difference between the occasional blues and unrelenting suicidal depression. In the former instance, possibly forfeiting your right to possess a firearm could, in future circumstances, place you and your family in a vulnerable position.

My personal standard for how accurately I wish to answer a question is what is the higher good. In other words, if it was WW2 in Europe and I was hiding a Jewish person and was asked by the Gestapo if anyone else was in my house, would I lie to the Gestapo or would I give up the Jewish person? For the moral person, the choice is obvious.

The "higher good" provides a good rule of thumb. I agree that it is a moral choice.

ao wrote:

Your concern about having a procedure done is well founded. There are some nasty infections going around and incompetency is not that uncommon. I've recent been dealing with an issue myself but elected self care procedures that, fortunately (and with what I feel was divine intervention), seem to be resolving nicely. People in our area are known for making an 8 hour drive down to the Mayo Clinic to get care. I did it myself for elbow surgery and the outcome was excellent, with me returning to work very quickly. One has to be very discerning nowadays and do their research.

With regards to the model, it's still in planning and development. I'll PM you about it but think of creating and defining your own profession rather than being one that is already out there.

I'm mostly thinking about trying to set something up if society crashes. I've got medical insurance and will keep it as long as Obamacare is in force. It would be nice to set up a system where the different societal functions are around after the lights go out. I can see a system based on communal living where doctors practice, bakers bake, and those without needed skills provide the labor. No one would get rich, but most would survive. Actually, I see it where this lifestyle would provide an actual purpose that seems to be missing in modern society. It would be far from eutopian, but I feel I would thrive with these challenges.

My maternal grandmother was a cook for one of the royal families in German. She made a German beef marrow bone soup (Markklosschensuppe) that was phenomenal, my favorite dish along with her Maultaschen.

When we eat organic lamb, I always suck the marrow out of the bones. Love it.

Year ago, when people ate homemade soups with bone stock, they got the marrow, hyaline cartilage from joints, gelatin from connective tissue, bone minerals, etc., all in the broth. My grandparents had theses type of soups almost every day and I don't remember them having the joint problems that are so common today..

"Those who were naively applauding the implementation of Obamacare are, if they have their eyes and ears open, seeing a nightmare slowly unfolding."

I couldn't agree more. I was in a hospital on Friday as my dad was having surgery. I saw many physician's with ID tags that read 'Employee Physician'. The doctors are giving up their autonomy to work for a hospital in return for having their billing done for them. The hospital will take a 4% cut off the top. Pay for protection to stay employed...this will only work for so long as hospitals take a mandatory 2% cut in reimbursement come April 1, 2013.

I know several people in Ann Arbor who participate in a new medical model that is similar to Community Supported Agriculture (CSA) for basic health care. I don't know the details, but it's set up as a 501c3 nonprofit and everyone pays a fixed monthly fee. (This is probably just for basic health care; I assume there would be other fees for various procedures.) The idea of the members of a relatively small group sharing in the costs and benefits of care would really tighten up the feedback loop and encourage everyone to keep costs low. As E.F. Schumacher said, "small is beautiful".

The web site for the group in Ann Arbor is http://www.steinerhealth.org/csam.

about a decade ago I had an old line MD that refused to play the HMO game. He was strictly cash on the barrelhead. He said from a business model, it costs him a lot of business, but he also avoided the support staff, and in his words "the idiots that knew nothing about his patients". He tended to mostly use old line off patent drugs, suggesting most (but not all) new drugs were way too expensive and didn't do anything more than the old and cheaper old drugs.

We have taken skin out of the game, forcing somebody else to cover our expenses. With no skin in the game, there is no incentive to stay healthy, find the best alternatives, or even shop around. I have a relative that has gold plated health insurance. Every minor ache and pain his 80 year old body gets hit with, instantly starts the clock for multiple test procedures, the more expensive the better. His insurance company PAID for the same procedure three times, and he couldn't get anybody to pay attention to the misbilling.

I have a new doc, fairly young. I asked for a script of an older drug that works very well. He kept trying to get me to try the latest and greatest. Didn't understand why I was passing, as insurance covers everything but the copay. This old line script is cheaper than my copay and works just fine :)

To those interested, my grandmother on my father's side was Austrian so we had all sorts of soups that were not mainstream. German Knuckle Soup . I'll try the one you proposed here Ao. Try making your own beef stock. The key is to slowly roast the cracked bones in the oven prior to simmering them for 2-3 hours. About three lbs of bones will make about 8 cups of stock. You can freeze it or can it. Don't throw that Christmas turkey carcass away. That makes loads of stock.

WRT chicken or turkey stock, the longer it simmers the better. First time we did turkey stock, life got in the way and it literally simmered for FOUR DAYS. That stock was unbelievable. Took the left over turkey, some frozen vegtables, put it all in canning jars and pressure canned the best turkey soup we have ever tasted.

Getting and keeping people sick is big business. I know the cure for cancer and many other ailments. Close the FDA. Corporations should have to provide health insurance policies for the people who get sick on their product. $1 of every pack of cigarettes should go towards giving smokers health insurance through the manufacturers. McDonald's should offer healthcare to their eaters. Beer companies should provide auto insurance and accidental death policies.

i am already subsidizing other unhealthy choices people make like eating meat, or sugar, or smoking. I pay outrageous amounts of money for health insurance I never use so that you can get heart disease and lung cancer and diabetes and be surprised as to why. I guess I have bad genetics.

Cooked animal fats has clogged our brains and bodies. After being raised on them, I haven't eaten a bologna sandwich in over 25 years and don't intend on starting now. You are welcome to keep sucking the marrow.

But the following comment on the article evoked a measure of sadness as well.

"We're a hard working small business owner. We can't afford dental and we work 6 days a week. Our health insurance premium alone costs $1,600 a month (went up again this year) with a $10,000 deductible. I'm sorry - but while I feel for them - even hard working folks with small businesses are suffering. The reason our premium went up is because our state followed the Obama mandate to cover all adult children until they are 26. Someone has to pay. They anticipate a 40% increase next year for Obama care in this state alone. We would then have to file for bankruptcy or go without insurance along with paying their crappy fine. Go figure. This is what health care has done for us. We're all poor now. Instead of bringing the poor up to the middle class - they've managed to bring the middle class down to the poor levels."

It's quite plain to see how America is devolving into second world and even third world status as poverty increasingly becomes the norm rather than the exception.

P.S. As of April 1, we were hit with a 2% sequestration cut and a 7% MPPR cut from Medicare for a 9% haircut. And the private insurors are certain to implement similar cuts, once having sniffed the blood of this feeding frenzy. It's death by a thousand slow-motion piranha bites. It's sad to see the emerging demoralization (among those who are becoming fully aware of what's going on and what's to come) and to hear from some of the most experienced, skilled, talented, and dedicated professionals who are saying, enough is enough, and are either declining to treat Medicare patients or moving into other areas of work or simply retiring. It's a shame and a waste of some of the best human resources.

It's easy to hyperbolize government plans to help the needy as encouraging laziness but remember an innocent human has the right to life because human life is priceless. By this argument I can concede that people should be willing to pay a price to maintain life but surely you can't justify it not being at least affordable?

Finding jobs can be hard: even if everyone is a hard worker with good credentials, someone will always be better than you in some situation. Also, insurance companies often refuse to insure the people who need it the very most.

I hope you can understand how some deluded liberal like me can believe that an innocent child dying of a preventable disease because their parents didn't have 10 grand going spare is a notch less tragic than some corporate magnate settling for a silver Rolex. They're content with living in abject poverty thanks to an unfair system. So long as they can still live.

It's easy to hyperbolize government plans to help the needy as encouraging laziness but remember an innocent human has the right to life because human life is priceless. By this argument I can concede that people should be willing to pay a price to maintain life but surely you can't justify it not being at least affordable?

Finding jobs can be hard: even if everyone is a hard worker with good credentials, someone will always be better than you in some situation. Also, insurance companies often refuse to insure the people who need it the very most.

I hope you can understand how some deluded liberal like me can believe that an innocent child dying of a preventable disease because their parents didn't have 10 grand going spare is a notch less tragic than some corporate magnate settling for a silver Rolex. They're content with living in abject poverty thanks to an unfair system. So long as they can still live.

It's easy to hyperbolize government plans to help the needy as encouraging laziness but remember an innocent human has the right to life because human life is priceless. By this argument I can concede that people should be willing to pay a price to maintain life but surely you can't justify it not being at least affordable?

Finding jobs can be hard: even if everyone is a hard worker with good credentials, someone will always be better than you in some situation. Also, insurance companies often refuse to insure the people who need it the very most.

I hope you can understand how some deluded liberal like me can believe that an innocent child dying of a preventable disease because their parents didn't have 10 grand going spare is a notch less tragic than some corporate magnate settling for a silver Rolex. They're content with living in abject poverty thanks to an unfair system. So long as they can still live.

Workers of the world unite.

Turbine,

You called yourself a "deluded liberal." I agree. Perhaps you can educate me a bit. I consider myself to be a pragmatist. Pragmatically, I see finite limits in the real world. I never have been able to come up with a meaningful definition of "priceless." What does that mean to you?

If all human life is priceless to you, you should be willing to expend all your efforts to extend even one life, just one second. Of course, while expending all your resources for this exemplary goal, you would be wasting the very life that should be most precious to you. Does that seem wise? Realistic? Why then is it okay to use government force to promote this same ideal?

Your implied straw man argument about the corporate magnate settling for a silver Rolex to save an innocent child dying from a preventable disease ... speaks volumes about your misguided attitude. If the corporate magnate chose to do that, I'd consider that a charitable gesture (which I applaud.) Of course, there are many more innocents to save. What if the magnate settled for a bronze Rolex, or a plastic Timex? Think how many more could be saved. Of course, there will still be many more out there. There are more "needs" than the finite world can address.

Your last statement, "Workers of the world unite." ... to do what? Should the unemployed unite also? What about those who really don't care to work? Once united, will the "united YOU" extort corporate magnates for higher pay? If that were to occur, the magnates would just have increased incentive to replace as many workers as possible with robotics. At some point, it fails.

You may think that I'm just a cold hearted bastard, but I know who my father was; therefore, I'm not a bastard. I try to think beyond platitudes. I encourage you to do the same. Be leery of politicians who promise you the world in exchange for your vote. The world isn't theirs to give away.